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AU 2021 General Session: Part 2
Acting as its own company, the spin-off allows IBM to focus on different priorities while Kyndryl assists its customers with modernization efforts and management. Serving 75 out of the Forbes , Kyndryl will carry the important task of acting as the heart of business enterprises everywhere, according to Maria Winans pictured , chief marketing officer of Kyndryl. Together, each of us advance the vital systems that power human progress.
That is our purpose as a company. The company has front-line access to developing innovations across all industries, requiring connection and trust between the company and its users. Click here to join the free and open Startup Showcase event. Clumio brings its backup-as-a-service technology to Amazon S3 storage. The same advances in transportation technology that facilitate global travel by humans also allow the rapid transcontinental movement of infectious disease vectors. It has been hypothesized, for example, that the vehicle for the introduction of West Nile virus into the United States in , the first occurrence of this disease in the western hemisphere, was an airplane carrying an infected mosquito vector Cetron, That mosquito vectors can hitch rides in the wheel wells of airplanes is well known.
Controversial evidence also suggests that global warming, much of which is generated by human trade-related activities, may be leading to an increase in the geographic expansion and distribution of vectors. Historically, most food has been produced and consumed locally. Over the last two decades, however, as consumer demand and expectations have increased and as food production and processing activities have become more geographically fragmented e. More recently, changes in international trade law, including the establishment of the World Trade Organization WTO in , have altered even more dramatically the ways in which all products, food and others, are bought and sold.
For example, before the establishment of WTO in , trade in animals and animal products was conducted according to a policy of zero risk. Now, imported products are treated no less favorably than domestic products, at least with regard to animal health restrictions. The experience of bovine spongiform encephalopathy in the United Kingdom and Europe illustrates the tremendous risk that accompanies the seemingly unlimited growth and opportunity offered by new international trade regulations enforced by WTO. It is cause for alarm that many countries do not have comprehensive food safety programs integrated into their public health strategies.
The problem is not limited to the developing world or to food products imported from those nations. Outbreaks of foodborne illness have revealed several inadequacies in food safety regulation capabilities even in the United States. The free flow of food also raises serious concerns about the global spread of antibiotic resistance associated with the consumption of antibiotic-fed food animals.
In fact, given that the spread of capitalism and the free market is the main driving force behind globalization, the health sciences community might benefit from examining the ways in which this movement of capital affects emerging infectious diseases. An excellent demonstration of this point is the use of foreign capital to fund dam construction and other similar environmental modification projects, which almost always alter, either directly or indirectly, local vector ecologies and human—pathogen interactions. For example, not only is construction of the Three Gorges Dam on the Yangtze River in China altering the potential for the transmission of schistosomiasis and other diseases by disrupting local vector ecologies, but it is also increasing the risk of transmission even further by forcing people to leave their homes and live in highly concentrated areas.
In light of the damaging effects of many projects on their local and regional environments and public health, workshop participants suggested that perhaps current economic models need to be reexamined, and that the potential and costly public health ramifications of investment decisions need somehow to be incorporated into those models. As the public health ramifications of dam construction and other environmental modification projects illustrate, the growing international market and the increased mobility of the global population have already and will continue to play a central role in shaping the global infectious disease landscape, both literally and figuratively.
Other global developments discussed at the workshop have important public health implications as well, including globally fueled armed conflicts and the massive displacement of people, the inability to monitor and provide adequate health care to the continually growing numbers of mobile people displaced because of war or other reasons, the incapacity to monitor foodborne and trade-related infectious disease risks worldwide, and the growing actual and perceived threats of bioterrorism. These developments have at least one thing in common: if left unchecked, they could have profound and potentially devastating consequences for global public health. Some argue that as the global economy improves, the living conditions of poor populations will also improve.
As one participant suggested, however, this is not necessarily true. Poor countries of the world are still poor, violence is increasing, and the same diseases still exist. As information becomes easier to access in even the remotest corners of the world, everyone will know how everyone else is living and under what circumstances. Greater numbers of people will leave their homes in search of work and an improved quality of life, and greater numbers of people will be forcibly displaced. As the world population continues to grow, as urban areas in the developing world continue to expand and further strain their already resource-limited governments, and as the global marketplace continues to hone the already sharp demarcation in wealth—and health—that exists between rich and poor countries, the ensuing social unrest and loss of state control will likely fuel even more communal conflict, forced migration, and terrorism.
Unless the public health infrastructure is modified to accommodate the health care needs of mobile populations and unless the capacity to monitor mobile populations is strengthened, both pre- and postarrival, the United States and other developed countries will be unable to handle the massive influx of immigrant and refugee populations. The gap in the prevalence of TB between U. Other developed countries are experiencing the same phenomenon; for example, according to a study, 92 percent of all multidrug-resistant TB cases in Canada were imported Grondin, Not only are migrants and refugees more likely than the general population to become infected, but they also put others at risk.
Standards are therefore needed for monitoring the health of mobile populations. While such standards are necessary, however, they will not be sufficient. Unless their underlying causes are addressed, armed conflict and the threat of terrorism will continue to plague the world, drive mass migration, and increase the risk of the emergence and spread of infectious disease. In the case of wars, almost all of which involve the use of small arms, workshop participants cited limiting the availability of such arms as an example of a tangible step that could be taken, given that the legal small arms trade is amenable to modification through U.
As with the monitoring of mobile populations, unless the capacity to monitor the global transport of foodborne and trade-related vectorborne infectious diseases is improved, such diseases will continue to pose serious public health risks. Although some argue that the risk of imported foodborne disease is relatively low—at least in the United States and in comparison with the risk of domestically derived foodborne disease—others argue that the surprisingly low incidence of the former reflects more a lack of surveillance than a lack of disease. The — outbreaks of cyclosporiasis in North America, caused by contaminated raspberries imported from Guatemala see Box S-1 , may not be as isolated an incident as one might think.
One of the reasons this outbreak received so much attention was the scientific excitement surrounding the relatively newly discovered pathogenic culprit. Yet even if foodborne outbreaks caused by imported products are uncommon, the potential for such outbreaks is increasing. Cyclosporiasis Outbreaks in California. In a retrospective study, Mohle-Boetani and colleagues analyzed a number of factors that contributed to the recognition of cyclosporiasis during eight months of outbreaks in California in the spring of Finally, one of the most prominent features of the new global landscape is the increased threat of bioterrorism. As one participant put it, today we are standing at the crossroads of two historical trajectories: one stemming from a day in when Constantinople fell to the Turks after centuries of conflict between the Christian West and the Muslim East, an event that signified the end of the Middle Ages and the beginning of the Renaissance; the other stemming from an event that occurred nearly years later, when the British scientific journal Nature published an article by two young scientists, James Watson and Frances Crick, reporting the discovery of the DNA double helix.
Thus, as the world enters the twenty-first century, society is simultaneously witnessing the reemergence of conflict between western and eastern cultures, the denouement of the age of physics, and the ascendance of the age of biology. The result is the convergence of global terrorism and the widespread availability of molecular biology techniques. At the heart of this collision is the use of infectious disease as a weapon. The threat of increased bioterrorism was made real by the terrorist attacks of September 11, , and the subsequent mailing of letters laden with anthrax spores in October The challenges faced by international health programs have increased as a result.
The funds will be used to improve detection and surveillance systems, strengthen medical capabilities, improve planning and coordination, foster research, expand training exercises and communication strategies, and address policies that create bureaucratic barriers to strengthening the U. The promised funding will potentially provide many new opportunities to strengthen the U. This unprecedented level of funding offers a rare chance to make a difference in the surveillance and prevention of infectious diseases, although workshop participants expressed several concerns regarding the use and the sustainability of this funding.
The recent funding for biodefense initiatives is but one example of the many benefits of the globalization of efforts to combat microbial threats. Other benefits and advances include the growth and changing nature of training and research partnerships between developed and developing countries, the development of new treatments and vaccines that could potentially save millions of lives, and advances in information technology. Despite a century of European involvement and decades of U. Most such programs, such as that of the Liverpool School of Tropical Medicine, founded in Liverpool, England, in , were originally designed to develop Northern capacity and expertise in tropical medicine. However, to develop the global public health capacity needed to respond rapidly and effectively to an unexpected pandemic, whether introduced naturally or intentionally, more resources and focus must be directed toward strengthening the public health capacity of the developing world.
This collaboration empowers its Southern participants in a way that lays the groundwork for building a sustainable intellectual and public health capacity in that developing nation. The Fogarty International Center of the National Institutes of Health is undertaking similar efforts by planning and implementing a range of training programs overseas. The need to strengthen the public health capacity in the developing world should not, however, detract from the still urgent need to incorporate public health education and training into the curricula of U. A number of recent microbial threats have been zoonotic. To address these and other future threats effectively, links need to be established between medical and veterinary schools.
Human and animal health issues must be addressed in a coordinated manner if the public health workforce is to be trained to combat zoonotic diseases. Moreover, many practicing physicians in developed nations have never seen a case of measles, let alone malaria. Thus, transnational programs should continue to serve the original goal of strengthening the public health capacity in the North as well. After all, there is much to be learned in and from the developing world. Peru has a long and rich history of experience with infectious diseases. For example, Peruvian mummies have yielded evidence that the first known TB epidemic occurred in that country nearly 2, years ago.
Several hundred years ago, Spaniards introduced smallpox into Peru when they first landed on the shores of the Americas Peru, in turn, sent syphilis back to sixteenth-century Europe, where Spanish troops spread the epidemic throughout the continent. In the last 25 years, one-third of all new infectious diseases described in the published literature have been discovered in Latin America. North-south training partnerships are but one example of the type of multinational collaboration that the increasing interconnectedness of the world not only allows but demands. Workshop participants also cited the vital source of expertise and knowledge of infectious diseases represented by scientists from the former Soviet Union and the potential role Russia could play in transnational public health education and training.
Russia has been participating in other international efforts to prevent and control the emergence and reemergence of infectious diseases. The country is experiencing the emergence and reemergence of multiple infectious disease agents, from hepatitis A virus to HIV and is on the verge of experiencing major epidemics. This crisis has been attributed to the tremendous economic, social, and public health fallout from the dissolution of the former Soviet Union. The pieces have yet to come back together again, and Russian leaders are urgently in need of a new public health paradigm.
As the situation in Russia demonstrates, taking full advantage of new global opportunities does not necessarily come easily. Antiretroviral agents, for example, have more than proven their public health worth in the United States and other developed countries for the treatment of HIV and other infections. It would be neither prudent nor practical to apply the U. HIV infections resistant to antiretroviral agents have already become a serious problem in the United States, in part because of premature introduction of the drugs; if resistance to these agents emerges in Africa, it is likely that no amount of money or political will be able to stem the resulting crisis.
In addition, although vaccines have more than earned their reputation as one of the greatest public health tools in history, their utility in many developing countries is limited by weak or nonexistent public health infrastructures and a lack of resources. Despite the early successes of the Global Alliance for Vaccines and Immunization—formed in in response to the growing gap in levels of vaccine usage between developed and developing countries—numerous impediments to accelerating the global deployment of the available vaccines remain. For example, the limitations imposed by local conditions must be accounted for if new public health measures are to be implemented and new technologies transferred. Also, in the rush to achieve desirable short-term outcomes, local programs tend to be scaled up rapidly.
The sudden infusion of billions of dollars into these systems, however, raises the question of how quickly this money can be spent wisely. Too often, hasty decisions have detrimental long-term consequences, and the cure ends up being worse than the problem. Drug and vaccine delivery is only half of the problem. Equally urgent is the need to redress the imbalance between drug research and development efforts directed toward developed and developing nations. As one participant noted, although pharmaceutical companies have produced more than 2, new compounds over the last decade, only six of these are for the treatment of tropical diseases. As the global economy becomes even more interconnected, this will likely become an extremely difficult challenge to overcome.
Global surveillance is another example of a tool that holds tremendous promise but still faces many difficult political, scientific, and coordination challenges. Many countries fail to report local outbreaks in an effort to avoid potentially huge negative economic and political repercussions, such as trade sanctions and travel advisories. For several reasons, international reactions to public reports of infectious disease outbreaks typically far exceed what is warranted by the actual situation and public health risks. Even regional surveillance can be difficult to achieve, as the efforts in the Caribbean demonstrate Corber, A novel but for the most part untested idea introduced during the workshop was the establishment of a global public health bank for the storage and distribution of limited resources that might otherwise not be used to their maximum advantage.
It was suggested that this program could be managed by a global health broker and would enable resources to be shared across borders Timpieri, Finally, most would agree that the Internet offers obvious and tremendous potential for infectious disease surveillance, prevention, and control. Never before have information and data been so easy to access and share. A number of factors account for these changing perceptions. First and foremost, support for international health efforts is no longer perceived as a costly charity endeavor; rather, it has become a cost-effective way of doing business. Even a century ago, millionaire ship owner Sir Alfred Lewis Jones founded the Liverpool School of Tropical Medicine, which sponsored 32 expeditions to the tropics between and Jones and other members of the Liverpool, England, business community recognized the wisdom of investing in the study of tropical diseases given that employee illnesses and deaths from malaria abroad led to reduced productivity and increased health expenditures at home.
Not only is poor public health bad for business, but it also threatens international political stability and U. For example, at the same time that high HIV infection rates in sub-Saharan Africa limit the potential for international trade partnerships, they threaten the political and social stability of the entire region, thus posing a significant national security risk to the United States.
The situation is exacerbated when armed forces are hit by high HIV infection rates, weakening military and peace-keeping capacities. Despite increased funding and dramatic changes in the general perception of international health, several participants agreed that strengthening the global capacity to prevent and control the emergence and spread of infectious diseases will require even more money and newer approaches. Others emphasized the importance of recognizing the difference between the need for more money and the need to spend the available money more wisely. Without a strong infrastructure and knowledge base in place, large influxes of money are often wasted.
It is crucial, therefore, that international systems and local agencies have the capacity to program significant amounts of money effectively. With regard to the need for a global mind-set, the colors of the geopolitical map in no way reflect what is going on epidemiologically. A rational approach to infectious disease control must be based on science, not political boundaries. At the same time, however, public health agencies are generally constrained by the reality that they operate according to politically defined organizational structures.
India, for example, has more than 50 different zones, each with its unique epidemiological conditions, yet the country is treated by WHO as a single unit or member state Miller, Since , the Centers for Disease Control and Prevention CDC has attempted to define its mission in a more global context by taking a global approach to infectious diseases.
This strategy can serve as a point of reference for the development of national, regional, and global strategies for addressing the globalization of infectious diseases. Public—private partnerships serve as a vital conduit for providing public health care supplies and services to populations, particularly in the developing world, that would otherwise not receive them. Examples include a multitude of recently developed innovative, achievement-oriented joint venture collaborations and partnerships involving the privatization of health care delivery services, with the public sector setting the rules and monitoring the quality of service.
These arrangements are characterized by their mutually beneficial nature and shared decision making, among other attributes. Yet despite the clear and growing demand for the participation of multinational corporations in these partnerships and in global health efforts in general, engaging their full interest still poses a considerable challenge. This situation is very worrisome. The Global Fund to Fight AIDS, Tuberculosis, and Malaria, for example, may not be sustainable without the commitment of nongovernmental entities, in terms of not only financing, but also technical and intellectual support.
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